EyeWorld India September 2017 Issue

by Rich Daly EyeWorld Contributing Writer One way to match IOLs to patients’ visual goals continued on page 36 Carefully constructed questionnaires can help surgeons connect clinical options to patients’ needs and desires T he goal of high patient visual satisfaction is more attainable than ever due to a growing variety of IOL options. But more options have also increased the need for effective communication tools to find the best match. “The answer to the question of which patients do best with which IOL has become much more com- plex as our available options for IOLs have expanded,” said Steven Dell, MD , medical director, Dell Laser Consultants, Austin, Texas. Among the growing number of IOL options are multifocal IOLs with a variety of near add powers with and without astigmatic cor- rection, accommodating IOLs with and without astigmatic correction, and an entirely new category of extended depth of focus (EDOF) IOLs with and without astigmatic correction. Many surgeons blend these technologies, with different IOLs placed in the right and the left eye. Surgeons may also use a small amount of defocus in one eye to expand the functional range of near vision. “With all of these options, the choice of which IOL is best for patients depends a lot upon their current visual situation as well as their visual goals after surgery,” Dr. Dell said. “Quickly and accurately assessing these goals is important in achieving high degrees of pa- tient satisfaction.” Reading key One important assessment involves determining a patient’s habitual reading distance, according to Rosa Braga-Mele, MD , professor of ophthalmology, University of Toronto. “Different IOLs address differ- ent reading distances,” Dr. Braga- Mele said. “Higher add multifocal IOLs (MFIOLs) are better at 35 to 40 cm, and lower add MFIOLs or EDOF are better at 45 to 48 cm reading distances. It depends on what the patient wants.” Additionally, it is important to determine which eye is dominant. Matching IOL options to patients’ habitual reading dis- tance has become more important amid the proliferation of reading formats, including physical books, tablets or e-readers, and laptops or desktops. “All of these options involve different working distances, which requires a tailored approach to selecting an appropriate IOL solu- tion,” Dr. Dell said. He noted that patients with short arms will typically read at a significantly different working distance than a tall patient with very long arms. Equally important is the pa- tient’s current refractive error. “A 2-D myope who removes glasses to read will be highly at- tached to his or her current work- ing distance,” Dr. Dell said. Questionnaires help In 2004, Dr. Dell’s practice launched a questionnaire to assess patients’ visual function goals. “The questionnaire was de- signed to force patients to make difficult choices and to determine how willing they would be to make optical compromises,” Dr. Dell said. Initially designed to expedite patient flow amid the advent of presbyopia-correcting IOLs, the questionnaire quickly assesses interest in presbyopia correction while simultaneously educating patients about various treatment options. The questionnaire became widely used and has been trans- lated into multiple languages. A new version of the question- naire, which includes assessments of the latest available IOL options and digital reading devices, has added a self-test to determine ha- bitual reading distance. The self-test utilizes a printed version of the questionnaire on a standard 8.5- × 11-inch sheet of paper, and roughly assesses read- ing distance by using the verti- cal length of the paper. Patients assess the number of vertical paper lengths at which they typically hold reading materials from their The latest version of the Dell Cataract and Refractive Lens Exchange Questionnaire has several changes from an earlier version, including the addition of a self-test to determine habitual reading distance. Source: Steven Dell, MD 35 EWAP CATARACT/IOL September 2017